Urology Coding Alert

Question: My urologist is doing a robot assisted laparoscopic radical prostatectomy for prostate cancer and a robot assisted lap anterior urethropexy (a lap MMK). When we bill the MMK and retropubic fat excision (which the doctor says takes 15-20 minutes on its own), the MMK and fat excision are being denied. What am I doing wrong?

Maryland Subscriber

Answer: Without knowing the exact codes you are billing, it's difficult to say what you're "doing wrong," if anything. This is a tricky area as the use of laparoscopy and robot assistance is fairly new and coding does not always keep up with changing technology. Here is how you should report the procedure:

For the laparoscopic robotic-assisted prostatectomy, you should report 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed). Note that robotic assistance is included in this code. The notation of "includes robotic assistance, when performed" means you should not you cannot additionally report codes S2900 (Surgical techniques requiring use of robotic surgical system [list separately in addition to code for primary procedure]) anymore.

Then, for the laparoscopic robotic-assisted MMK procedure, report 51990 (Laparoscopy, surgical; urethral suspension for stress incontinence). (If you are using a sling instead of MMK, you would report 51992, ... sling operation for stress incontinence [e.g., fascia or synthetic].)

Note: The intraoperative retropubic fat excision is included in this coding. You cannot separately report that. 15-20 minutes is not enough "extra" time over and above typical time to really ask for additional reimbursement using modifier 22 (Increased procedural services), for example.

Official guidance: This method of coding for laparoscopic MMKs was recently addressed in the CPT Assistant® March 2012 edition. The AMA instructed: "The robotic prostatectomy is reported with code 55866, and the laparoscopic robotic MMK urethropexy is reported separately with code 51990 or code 51992."

That said, not all payers follow AMA guidance and often will deny payment of the laparoscopic MMK. Your payer ultimately has the ability and discretion to not pay for this service or to require another way of coding. If you are billing these codes and still getting denials, you should appeal and send along a copy of the CPT Assistant® guidance on billing this way. It may help or it may not, unfortunately.